Employment Application

Employment Application

We are an equal opportunity employer. We do not discriminate in employment practices because of race, color, sex, age, national origin, disability, military or veteran status.


Instructions: This application will take 30 - 60 minutes to complete, be sure that you have all requested information before you start. Please print in ink or type and complete all information. Your signature authorizes us to secure necessary data.

Personal Information

Employment Desired

Baxley

Brooks
 
Carrollton

Meansville
 
Mt. Airy

Newnan
 
Palmetto

Warm Springs
 
Administrative Assistant

Camp Counselor

Case Manager

Community Support Staff
 
Direct Care Staff

Director of Services

Nurse

Program Coordinator
 
Program Specialist

Support Services

Teacher

Therapist
 
Full-Time
 
Part-Time
 
Internship
 
Volunteer
 
GBCH&FM Employee

GBCH&FM Website

Local Church
Friend

Newspaper

Christianjobs.com
Other

Education

Name and Address of School
Course of Study
Years Completed
Diploma/Degree
Fluent
Good
Fair

Please list all volunteer work you have participated in: (You may exclude any volunteer work which would reveal gender, race, national origin, age, disability, or other protected status.)

Please describe any specialized training, skills, extra-curricular activities, hobbies, or recreational activities you have participated in: (You may exclude any activities which would reveal gender, race, national origin, age, disability, or other protected status.)

Employment Experience

Start with your current or most recent job, and list all jobs held since you graduated from high school.

Personal References

Name of character reference NOT a relative OR a former employer.

General

Have you ever been convicted of, or pleaded guilty or nolo contendere to a crime?

A criminal conviction is not an absolute bar to employment. Are there any felony charges pending against you?

Charges Pending

Do you use any of the following?

Do you use illegal drugs, or take controlled substances without a proper prescription?

Have you ever been convicted of DUI? Answer this question only if you are applying for a job that requires driving as a part of your job duties.

Please review your answers carefully and read each paragraph before signing below.


By my signature below, I affirm that the information provided in this employment application is true and complete. I understand that if employed, and false information or omissions shall be considered sufficient cause for dismissal without any obligation or liability to me other than for payment, at the rate agreed upon, for services actually rendered. I agree to immediately notify GBCH&FM if I should be charged with, convicted of, or plead guilty or nolo contendere to a felony of any kind, or any crime involving dishonesty or breach or trust, or any crime against a minor, or any crime involving an allegation of sexual misconduct or impropriety.

I authorize the investigation of all statement contained in this application. I also authorize GBCH&FM to contact my present employer (unless otherwise noted in this application form), past employers and listed references and other references that might know of my qualifications for employment. I authorize any person, school, current employer, past employer(s), and organizations to provide GBCH&FM with any information and opinions, whether or not documented, and I hereby release them from any legal liability in providing such information.

I understand and agree that, if offered a job, I may be required to submit to a drug/alcohol test at the time of the offer and at any time during employment. If not employed, this application will be retained for 24 months for future reference. (If employed, the employment application will become part of your personnel file.)

I UNDERSTAND AND ACKNOWLEDGE THAT, UNLESS OTHERWISE DEFINED BY APPLICABLE LAW, ANY EMPLOYMENT RELATIONSHIP WITH THIS ORGANIZATION IS OF AN "AT WILL" NATURE, MEANING THAT THE EMPLOYEE MAY RESIGN AT ANY TIME AND THE EMPLOYER MAY DISCHARGE EMPLOYEE AT ANY TIME WITH OR WITHOUT CAUSE. IT IS FURTHER UNDERSTOOD THAT THIS "AT WILL" EMPLOYMENT RELATIONSHIP MAY NOT BE CHANGED BY ANY WRITTEN DOCUMENT OR BY CONDUCT UNLESS SUCH CHANGE IS SPECIFICALLY ACKNOWLEDGED IN WRITING BY AN AUTHORIZED EXECUTIVE OF THIS ORGANIZATION.

I also understand that applications submitted electronically, via e-mail or similar media, are not valid unless I enter my name in the signature field below and such action shall constitute an electronic signature.

Signature is required for application to be processed.

An authorization for a motor vehicle report, and a criminal records check will be signed at or following the interview. If you are employed, an immigration verification and a physical examination will be required.


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